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Barriers Impact on Primary Care Accessibility for Low Income Families

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Access to comprehensive, quality health care services is important for promoting and maintaining health, preventing and managing disease, reducing unnecessary disability and premature death, and achieving health equity for all Americans. This topic area focuses on 3 components of access to care: insurance coverage, health services, and timeliness of care. When considering access to health care, it is important to also include oral health care and obtaining necessary prescription drugs

Access to health services means "the timely use of personal health services to achieve the best health outcomes.

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Poverty is widely recognized as a major determinant of poor health. The powerful link between income and health has been well documented -- people living on low income consistently have higher rates of morbidity and mortality due to chronic and acute illnesses. This impact is particularly worrisome amongst children, who exhibit a higher risk of detrimental health outcomes throughout their life-course regardless of later socioeconomic status. Nonetheless, there are few studies of how family physicians respond to the social problems, such as poverty, inadequate housing, or food insecurity, experienced by their patients

This gap may partly be due to the fact that research into the social determinants of health has largely been focused on policy-level and public health-based interventions. Very little has been done to directly examine primary health care providers' responsiveness to income as a risk factor for health. Moreover, while family medicine has a strong history of addressing issues once considered social, such as smoking and obesity, income remains largely unaddressed in primary care. As a step towards the development of potential direct interventions by primary care providers, this study examines some of the current barriers to effectively addressing poverty as a risk to health in the province of Ontario, Canada. There is a nuanced literature discussing access to health care for different populations, however access to care for people who live at low income has been less well-explored. Existing evidence points to significant barriers to people living on low income receiving high quality primary care that is responsive to their social circumstances.

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Although it is 1 of the wealthiest nations, the rate of poverty in the United States continues to exceed that of many other industrialized nations. Poverty has been consistently linked with poor health and increased risk for psychological disorders in children and adults that can persist across the life span.1–3 Despite the mental health needs of families living in poverty, few gain access to high-quality mental health services.4–6 There is a growing urgency to develop models of mental health care that are tailored to the needs of these vulnerable children and their families. Pediatric primary care providers (PCPs) are in a unique position to take a leading role in this effort because families often turn to them first for help with mental health concerns (Bradley RH, Corwyn RF., 2002). Although there are a number of systemic, cultural, and individual barriers to accessing mental health care, promising interventions and integrated behavioral health care models have emerged that can be implemented in the primary care setting to help PCPs close the enormous gap between mental health needs and access for children and families experiencing poverty.There are disparities in poverty rates depending on age, race or ethnicity, family structure, and geographic location. Although the largest number of poor and low-income children are white, minority children are disproportionately affected, particularly African American, American Indian, and Hispanic children. In 2013, Hispanic and African American children were ∼3 times more likely than white and Asian children to be poor ( Lugo-Gil J, Tamis-LeMonda CS., 2008).

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Generally speaking, many private foundations work to improve healthcare access by funding transportation services, improving workforce, and addressing other factors that affect rural healthcare access

Investing in existing safety net providers and programs, offering grants to develop and implement innovative healthcare delivery models, and funding research to study policy implications as they relate to rural healthcare access are all examples of actions foundations can take to support rural healthcare access.

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Lugo-Gil J, Tamis-LeMonda CS. Family resources and parenting quality: links to children’s cognitive development across the first 3 years. Child Dev. 2008;

Weaver IC, Cervoni N, Champagne FA, et al. . Epigenetic programming by maternal behavior. Nat Neurosci. 2004;7(8):847–854

Pelton LH. The continuing role of material factors in child maltreatment and placement. Child Abuse Negl. 2015;41:30–39

Bradley RH, Corwyn RF. Socioeconomic status and child development. Annu Rev Psychol. 2002

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